Heart failure is a prevalent condition associated with high morbidity and mortality. The rapid evolution and widespread adoption of artificial intelligence applications have significantly advanced in the field of medicine. We aim to assess the value and reliability of ChatGPT 4o, Gemini, and Bing Chat’s responses regarding heart failure. A list of fifty commonly asked questions regarding heart failure was asked twice to ChatGPT 4o, Gemini, and Bing Chat. Two experienced cardiologists assessed each the natural language processing models’ answers without knowing each other’s scores. The content of answers was evaluated using the following scale: correct (1), partially correct (2), a mix of accurate and inaccurate (3) and completely inaccurate (4). Most answers were correct or partially correct; only Bing Chat gave some inaccurate responses, unlike ChatGPT-4o and Gemini. In terms of ‘correct’ answers, ChatGPT scored 88%, Gemini scored 70%, and Bing Chat scored 64%. ChatGPT 4o provided the highest ‘reproducible’ score at 88%, followed by Gemini at 86% and Bing Chat at 72%. This study demonstrated that ChatGPT 4o, in particular, has the ability to produce valuable responses to patient inquiries regarding heart failure. In the future, as chatbots are further investigated and improved, these models may have the potential to be utilized by both patients and healthcare professionals for managing chronic conditions like heart failure.

Objective: Coronary artery disease (CAD) is the leading cause of morbidity and mortality globally.The growing interest in natural language processing chatbots (NLPCs) has driven their inevitable widespread adoption in healthcare.The purpose of this study was to evaluate the accuracy and reproducibility of responses provided by NLPCs, such as ChatGPT, Gemini, and Bing, to frequently asked questions about CAD.Methods: Fifty frequently asked questions about CAD were asked twice, with a one-week interval, on ChatGPT, Gemini, and Bing.Two cardiologists independently scored the answers into four categories: comprehensive/correct (1), incomplete/partially correct (2), a mix of accurate and inaccurate/misleading (3), and completely inaccurate/irrelevant (4).The accuracy and reproducibility of each NLPC's responses were assessed.Results: ChatGPT's responses were scored as 14% incomplete/partially correct and 86% comprehensive/correct.In contrast, Gemini provided 68% comprehensive/correct responses, 30% incomplete/partially correct responses, and 2% a mix of accurate and inaccurate/ misleading information.Bing delivered 60% comprehensive/correct responses, 26% incomplete/partially correct responses, and 8% a mix of accurate and inaccurate/misleading information.Reproducibility scores were 88% for ChatGPT, 84% for Gemini, and 70% for Bing. Conclusion:ChatGPT demonstrates significant potential to improve patient education about coronary artery disease by providing more sensitive and accurate answers compared to Bing and Gemini.

OBJECTIVE:Catheter-based ablation is now widely recognized as a beneficial therapeutic option for managing atrial fibrillation (AF). However, the extended duration and pain associated with the procedure may cause patient movements, potentially leading to disruptions in the electro-anatomical mapping systems. Sedative and analgesic agents are used to prevent body movements and manage pain. This study aimed to conduct a comparison between the safety and effects of ketamine and propofol for deep sedation on outcomes in AF patients undergoing radiofrequency ablation. METHODS:This retrospective and single-center study included 108 patients who underwent radiofrequency AF ablation under deep sedation (without intubation) in our hospital. The patients were categorized into two groups based on the anesthetic agent administered for deep sedation: the propofol group and the ketamine group. Procedure duration, success rates, and recovery times were compared. RESULTS:Of the 108 patients, 54 were in the propofol group and 54 were in the ketamine group. The procedure durations were similar in both groups (propofol group: 135 min (120 - 145) vs. ketamine group: 140 min (120 - 155), p=0.803). The eye-opening time after the procedure was 275 seconds in the propofol group and 266 seconds in the ketamine group (p=0.530). Additionally, no significant variation was detected in the initial measurements of systolic and diastolic blood pressure or heart rate. CONCLUSION:In conclusion, there was no significant difference between the propofol group and the ketamine group in terms of outcomes. To the best of our knowledge, this is the first study to assess the efficacy of ketamine and propofol in the radiofrequency AF ablation patient group.

Malnutrition is common among elderly patients, often leading to severe complications. This study sheds light on the connection between malnutrition and the occurrence of atrial high-rate episodes (AHREs) and atrial fibrillation (AF), as well as all-cause mortality, in individuals aged 80 and older (octogenarians) with dual-chamber permanent pacemakers (DCPM). We employed the Controlling Nutritional Status (CONUT) score and Prognostic Nutritional Index (PNI) to assess malnutrition status effectively. In this comprehensive retrospective analysis, we evaluated 324 octogenarians who underwent DCPM implantation and received consistent long-term monitoring at a leading tertiary cardiac clinic. Participants were classified into three nutritional status categories based on their CONUT scores. During long-term follow-up, the incidence of AHREs did not differ significantly across CONUT score categories; however, AF and the combined endpoint of AHREs + AF were significantly higher in the moderate-to-severe malnutrition group (p < 0.001). Long-term mortality rates increased progressively from normal CONUT scores to moderate-to-severe scores. In the adjusted Cox model, mild malnutrition was associated with a 3.6-fold increased risk of mortality (95

OBJECTIVE:Hypertrophic cardiomyopathy (HCM) is a common hereditary cardiac disorder. Clinical presentations in the Turkish population may differ from those observed in other countries. This study aimed to evaluate the relationship between the sudden cardiac death (SCD) risk score and long-term mortality in low-risk HCM patients and to identify predictors of long-term mortality. Additionally, it investigated the clinical characteristics and outcomes of HCM patients at a tertiary cardiology center. METHOD:Between 2004 and 2021, a total of 340 HCM patients without implantable cardioverter defibrillators were followed at a single tertiary cardiology center in Türkiye. This was a retrospective study. The HCM Risk-SCD score was used to integrate demographic and clinical variables to estimate the predicted five-year risk of death. Patients with an HCM Risk-SCD score of less than 4% were divided into three equal tertiles, ranging from low to high SCD scores. These tertiles were then compared. RESULTS:Our study identified older age [hazard ratio (HR) 95% confidence interval (CI): 1.048 (1.018-1.080)], a history of cerebrovascular accident [HR 95% CI: 3.675 (1.158-11.656)], and elevated neutrophil count [HR 95% CI: 1.450 (1.250-1.681)] as independent risk factors for long-term mortality in the cohort with HCM Risk-SCD < 4%. The receiver operating characteristic (ROC) curve demonstrated that the optimal HCM Risk-SCD threshold for predicting long-mortality in the overall study cohort was > 1.79, with 55% sensitivity and 55% specificity (area under the curve (AUC): 0.60, 95% CI: 0.52-0.69, P < 0.001). No statistically significant difference in long-term mortality was observed among the tertiles in the Kaplan-Meier analysis (P = 0.296). CONCLUSION:Advanced age, cerebrovascular accident, and elevated neutrophil count are independent predictors of long-term mortality in patients with an HCM Risk-SCD score < 4%. Patients classified as low risk should undergo further evaluation using complementary tools to help prevent SCD.

Background:Electrical cardioversion (ECV) is a technique used to restore sinus rhythm in atrial fibrillation (AF), aiming to reduce AF-related symptoms. Various recurrence predictors, such as non-paroxysmal pattern, prolonged duration, chronic obstructive pulmonary disease, advanced age, or left atrial dilation, have been identified. Hence, the aim of our study was to determine the parameters that could predict AF recurrence in the long term in patients who underwent ECV. Methods:One hundred seventy-two patients who underwent electrical cardioversion due to AF at our tertiary center were included in the study. Patients with recurrent AF after cardioversion were defined as the AF recurrence (+) group, and those with normal sinus rhythm were defined as the AF recurrence (-) group. Parameters that would predict AF recurrence were investigated between these two groups. Results:AF recurrence was observed in 91 patients, while 81 patients did not experience any recurrence. The prediction model, constructed using multivariate Cox regression analysis, included six variables: non- high-density lipoprotein (HDL) cholesterol, free T3, mean corpuscular volume (MCV), left atrium anterior-posterior diameter, number of cardioversions, and oral anticoagulant use. ROC curve analysis demonstrated that our prediction model effectively distinguished between patients with arrhythmia relapse and those without, with an AUC value of 0.719 (p < .05). Conclusions:This study revealed that AF recurrence after ECV can be predicted by our prediction model consisting of patient characteristics, disease factors, and various biochemical parameters. The current study demonstrated a statistically significant association between the number of cardioversions and non-HDL cholesterol levels in patients with recurrent AF.

Rupture of a sinus of valsalva aneurysm (SVA) and the development of an aorto-right ventricular fistula (ARVF) is a rare condition, associated with high morbidity and mortality rates if left untreated. Opening of the SVA rupture into the right heart chambers may result in various morbidities, such as pulmonary hypertension. We present a case of a patient who developed ARVF following sutureless aortic valve replacement, and was subsequently treated successfully via a percutaneous approach.

BACKGROUND:There is some discrepancy in current studies concerning the effect of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) on right ventricular (RV) functions in heart failure (HF) patients. Hence, this meta-analysis was focused on determining the impact of SGLT2i on RV functions in such individuals.MATERIAL AND METHODS:Two independent investigators searched PubMed, Google Scholar, and the Cochrane Library for articles of interest. To analyze heterogeneity, Higgins' I2 as well as prediction intervals and Egger's test were used to assess heterogeneity. The Newcastle-Ottawa standard ratings approach was used to assess the quality of observational studies. The ROBINS-I risk of bias algorithm was used to assess bias risks of randomized studies.RESULTS:This meta-analysis evaluated 8 studies in total. Over the follow-up time frame, patients who used SGLT2i had substantially lower systolic pulmonary artery pressure and higher tricuspid annular plane systolic excursion values (mean difference [MD] = -5.23 [-7.81; -2.66] and, MD = 1.47 [1.01; 1.93]; P <0.01, respectively). There was no significant difference in RVS' values between follow-up and baseline (MD = 1.54 [-0.19; 3.26]; P = 0.08). However, as compared to the baseline period, fractional area contraction values were substantially larger at the end of the follow-up (MD = 5.52 [4.23; 6.82]; P <0.01).CONCLUSION:To the best of our knowledge, this is the first meta-analysis assessing the impact of SGLT2i on RV function in HF patients. Our findings suggest that SGLT2i may improve RV performance in HF patients.

Background:The treadmill exercise test is widely used to determine cardiovascular risk and mortality. Premature ventricular complexes (PVCs) are frequently observed during exercise stress testing. The literature on the role of PVCs observed during treadmill exercise testing in predicting prognosis is controversial. Hence, we aimed to evaluate the clinical results of PVCs seen during exercise testing in patients without obstructive coronary artery disease confirmed by coronary angiography (CAG).Methods:The study population consisted of 1624 consecutive patients who were considered high risk according to the Duke treadmill risk score and had no significant stenosis on CAG from January 2016 to April 2021. The primary endpoints of the study were long-term all-cause mortality of patients who had PVCs during the exercise test or during the resting phase.Results:Long-term mortality was observed in 53 of the 1624 patients after a mean follow-up of 47 months. PVCs were observed in 293 (18.7%) patients without long-term mortality, and in 24 (45.3%) patients with long-term mortality (p < 0.001). The model adjusted for all covariates showed that the presence of PVCs in the recovery phase [p < 0.007, hazard ratio (HR) (95% confidence interval (CI)) 2.244 (1.244-4.047)] and advanced age [p < 0.001, HR (95% CI) 1.194 (1.143-1.247)] were associated with long-term all-cause mortality.Conclusions:PVCs observed during treadmill exercise testing and the recovery phase were related to long-term mortality in patients without obstructive coronary artery disease.

Abstract Introduction ST-segment elevation myocardial infarction (STEMI) represents the most harmful clinical manifestation of coronary artery disease. Risk assessment plays a beneficial role in determining both the treatment approach and the appropriate time for discharge. Hierarchical agglomerative clustering (HAC), a machine learning algorithm, is an innovative approach employed for the categorization of patients with comparable clinical and laboratory features. The aim of the present study was to investigate the role of HAC in categorizing STEMI patients and to compare the results of these patients. Methods A total of 3205 patients who were diagnosed with STEMI at the university hospital emergency clinic between 2015 and 2023 were included in the study. The patients were divided into 2 different phenotypic disease clusters using the HAC method, and their outcomes were compared. Results In the present study, a total of 3205 STEMI patients were included; 2731 patients were in cluster 1, and 474 patients were in cluster 2. Mortality was observed in 147 (5.4%) patients in cluster 1 and 108 (23%) patients in cluster 2 (chi-square P value < 0.01). Survival analysis revealed that patients in cluster 2 had a significantly greater risk of death than patients in cluster 1 did (log-rank P < 0.001). After adjustment for age and sex in the Cox proportional hazards model, cluster 2 exhibited a notably greater risk of death than did cluster 1 (HR = 3.51, 95% CI = 2.71–4.54; P < 0.001). Conclusion Our study showed that the HAC method may be a potential tool for predicting one-month mortality in STEMI patients.

Aim: There is a lack of data about the association between admission serum albumin levels and long-term mortality in heart failure (HF) patients with cardiac resynchronization therapy defibrillators (CRT-D). We aim to investigate this connection in HF patients with CRT-D. Methods: The study population consisted of 477 HF patients with CRT-D. The cohort was divided into three groups according to albumin values, and the relationship between these groups and long-term mortality were evaluated. Results: Long-term all-cause mortality (HR: 3.32, 95% CI: 2.12-6.84), appropriate (HR: 4.44, 95% CI: 2.44-8.06) and inappropriate (HR: 2.95, 95% CI: 1.88-6.02) shocks were higher in the low albumin group. Conclusion: Low albumin levels are associated with the long-term mortality and appropriate shock treatment in HF patients with CRT-D.

Background: The hypertrophic cardiomyopathy (HCM) risk- sudden cardiac death (SCD) model provides a convenient tool for determining the risk of SCD in patients with HCM even though some patients with low-risk scores still remain at risk of SCD. Hence, the aim of our study was to assess the performance of HCM Risk-SCD in a large series of consecutive patients with HCM who had been followed up in a tertiary center.Methods: The study population consisted of 389 consecutive HCM patients who had been followed up between 2004 and 2021. Demographic and clinical characteristics, estimated 5-year risk using the HCM Risk-SCD model, were compiled, and survival data were collected during follow-up. Patients were divided into 2 groups according to their long-term survival, and HCM risk-SCD scores of these two groups were compared.Results: The long-term mortality was observed in 47 patients out of 389 patients in the during a mean follow-up of 55.5 +/- 12.7 months. The mean HCM Risk-SCD score of surviving patients was significantly lower than that of non-survivors (1.8% vs. 3.0%, p < .001). The HCM Risk-SCD score was above 6% in nine (2.6%) survivors and nine (19.1%) non-survivors (p < .001). The ROC curve based on the HCM Risk-SCD score had 61% sensitivity and 61% specificity for risk threshold of for 2.0%, 38% sensitivity and 99% specificity a threshold of >= 4%, 17% sensitivity, and 99% specificity for a threshold of >= 6%.Conclusion: A new risk algorithm with higher sensitivity is needed, although the HCM risk-SCD model is still quite useful in identifying patients at a high risk for SCD.

The Naples score is a new prognostic score developed according to inflammatory and nutritional status and frequently evaluated in cancer patients. The present study aimed to evaluate using the Naples prognostic score (NPS) to predict the development of decreased left ventricular ejection fraction (LVEF) after acute ST-segment elevation myocardial infarction (STEMI). The study has a multicenter and retrospective design and included 2280 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) between 2017 and 2022. All participants were divided into 2 groups according to their NPS. The relationship between these 2 groups and LVEF was evaluated. The low-Naples risk group (Group-1) included 799 patients, and the high-Naples risk group (Group-2) had 1481 patients. Hospital mortality, shock, and no-reflow rates were found to be higher in Group 2 compared with Group 1 (P < .001, P = .032, P = .004). The NPS was significantly inversely associated with discharge LVEF (B coefficient: -1.51, 95% CI-2.26; -.76, P = .001). NPS, a simple and easily calculated risk score, may help identify high-risk STEMI patients. To the best of our knowledge, the present study is the first to demonstrate the relationship between low LVEF and NPS in patients with STEMI.

The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.

Aim: Systemic immune-inflammation index (SII) is obtained by multiplying the platelets by the ratio of neutrophils to lymphocytes. We aimed to examine the relationship between contrast induced nephropathy (CIN) development and SII in non-ST-segment elevation myocardial infarction (NSTEMI) patients.Methods: 1124 NSTEMI patients included and divided into two groups according to the development of CIN. The relationship between SII and CIN development was examined.Results: Among two groups, significant differences were observed in terms of age, chronic renal failure, presence of critical stenoses in the LAD, SII and C-reactive protein (CRP). It was calculated that a value of 709 and above for SII had a predictive power with 74% sensitivity and 74% specificity for CIN.Conclusion: SII has the potential to predict the development of CIN in NSTEMI patients.

1 with considerable interest, which revealed geographic disparities in heart failure (HF) characteristics, including decreased mortality rates in socioeconomically impoverished areas of Türkiye.

Objective: Despite significant advances in understanding hypertrophic cardiomyopathy (HCM) in recent years, there is a need to improve risk stratification for patients at high risk of adverse outcomes. The relationship between inflammation and disease severity in HCM patients is known. Recently, a new inflammation parameter called the pan-immune inflammation value (PIV) has been introduced. However, the relationship between PIV and HCM has not yet been examined. Hence, we aim to investigate the effect of PIV on prognosis in a large series of HCM patients. Methods: The study included 389 consecutive patients with HCM admitted to a tertiary care hospital between 2004 to 2021. The PIV for patients was calculated as: Neutrophil count x platelet count x monocyte count / lymphocyte count. The cohort was categorized into three groups according to PIV, and the association between these groups and longterm mortality was evaluated. Results: Over an average follow-up period of 55.5 +/- 12.7 months, long-term mortality occurred in 47 out of 389 patients. Long-term mortality was recorded in 7 patients in tertile 1, 12 patients in tertile 2, and 28 patients in tertile 3. Multivariate regression analysis revealed that long-term all- cause mortality was 3.5 times higher in tertile 3 compared to tertile 1. The receiver-operating characteristic curve based on the PIV had 62% sensitivity and 65% specificity for long-term mortality. Conclusions: High PIV levels may serve as a predictor of long-term mortality in patients with HCM. PIV could be a useful screening tool for identifying HCM patients at increased risk of adverse outcomes.